Relationships between mastery, forgiveness, optimism, and resilience, and PTSD and anxiety during the COVID-19 pandemic

ABSTRACT

The COVID-19 pandemic has had devastating emotional consequences. The present study aimed to examine the relationships between personal resources and emotional distress while accounting for COVID-19–related variables. Seven hundred and seventy-seven (N = 777) participants completed demographic, mastery, forgiveness, optimism, resilience, PTSD, and anxiety questionnaires. A stepped hierarchical multiple regression revealed that mastery, forgiveness, cultural group, age, acquaintance with a person who died of COVID-19, and having been infected with COVID-19 contributed significantly to the explained variance in PTSD symptoms. Mastery, forgiveness, optimism, age, and acquaintance with a person who died of COVID-19 contributed significantly to the explained variance in anxiety. However, resilience was not found to significantly contribute to the explained variance in PTSD symptoms or anxiety. This study demonstrates the importance of being aware of both PTSD symptoms and anxiety associated with COVID-19. Thus, it is suggested that therapy programs should pay special attention to mastery and forgiveness as coping resources. In addition, among medical and mental-health personnel awareness should be given to individuals who have been in close acquaintance with those who died of COVID-19, those with COVID-19 risk factors, and those who have been infected. Special attention should also be paid to minority groups as they might tend to experience more emotional distress and trauma symptoms.

KEYWORDS:

• COVID-19
• emotional stress
• forgiveness
• mastery
• optimism
• resilience

Since the declaration of the COVID-19 as a global pandemic, there have been over 250 million confirmed cases of COVID-19, including over five million deaths (WHO, 2021). The psychological impact of COVID-19 has been examined in numerous studies, demonstrating the devastating emotional consequences of the pandemic (Cénat et al., 2020; Salari et al., 2020). Within this context post-traumatic stress disorder symptoms (PTSD) and anxiety have been demonstrated as significant emotional distress manifestations following the pandemic (Chamaa et al., 2021; Delpino et al., 2022; Saeed et al., 2022; Szepietowska et al., 2022).

Such circumstances require individuals to cope with and attempt to reduce their emotional distress. According to stress and coping models (e.g. Hobfoll, 1989, 2002; Lazarus & Folkman, 1986), internal resources play an important role in the coping process. When utilized efficiently and effectively, internal resources can alleviate and reduce emotional distress. Among those resources, mastery, forgiveness, optimism, and resilience have been found to be significant resources for coping with stressful and traumatic events (Besser et al., 2015; Gil & Weinberg, 2015; Weinberg et al., 2021). Therefore, the aim of this study was to examine the relationship between these internal resources and PTSD symptoms, as well as general stress following the COVID-19 pandemic among a multicultural population.

Mastery refers to an individual’s belief that he or she is able to influence and manage his or her life (Pearlin & Schooler, 1978). In stressful situations such as traumatic events or illness, higher levels of mastery are known to be associated with lower levels of stress (Ben‐tzur et al., 2021; Noh et al., 2012). Mastery has also been found to be negatively correlated with loneliness and depressive symptoms during the COVID‐19 pandemic (Fitzpatrick et al., 2020; Refaeli & Achdut, 2021).

Forgiveness is another internal resource that plays a significant role in efforts to cope with traumatic and stressful situations. Forgiveness is commonly defined as a decrease in negative feelings, thoughts, and behaviors toward a transgressor, or a change from negative to neutral feelings or from negative to positive feelings (Enright and The Human Development Study Group, 1996; Rye & Pargament, 2002; Worthington & Wade, 1999). Numerous studies have demonstrated that among those exposed to traumatic events such as terror attacks, war, and sexual assault, higher levels of forgiveness are related to lower levels of PTSD symptoms and emotional distress, as well as more effective coping (Ha et al., 2019; Ochu et al., 2018; Weinberg et al., 2017). Within the context of the COVID-19 pandemic, forgiveness has been found to be positively associated with gratitude and negatively associated with negative emotions (Pizarro-Ruiz et al., 2021; Tilkeridou et al., 2021).

An important resource that was found to be of great significance while coping stressful and traumatic situations is optimism (Cherry et al., 2017; Gil & Weinberg, 2015). Optimism reflects the expectation that one’s own outcomes will generally be positive (Carver & Scheier, 2014) and that stressful situations can improve in the future (Chang et al., 2013). Studies that have examined the relationship between optimism and emotional distress during the COVID-19 pandemic have demonstrated that optimism is associated with better mental health and less fear and depression (Levkovich et al., 2021; Vos et al., 2021).

Resilience has also been found to be of great importance when coping with stressful and traumatic encounters. Resilience is defined as the ability to maintain a dynamic system to adapt successfully to disturbances that threaten the functioning, survival, or development of a system (Masten, 2018). Resilience has protective effects on individuals experiencing or facing stressful or traumatic adversity (Lee et al., 2018; Stratta et al., 2015). It has also been found to be a significant resource for coping with emotional distress, depression, and anxiety related to COVID-19 (F. Li et al., 2021; Song et al., 2020).

The main goal of the present study was to examine the associations between mastery, forgiveness, optimism, and resilience, with PTSD symptoms and anxiety, during the pandemic. We hypothesized that higher levels of mastery, forgiveness, optimism, and resilience would be associated with lower levels of PTSD symptoms and anxiety. In addition, as minority groups have been found to be at higher risk for the development of PTSD (Xue et al., 2015), the current study also examined relationships between cultural group (Jewish and Arab participants) and PTSD symptoms and anxiety.

Method

Participants

The sample consisted of 777 participants. Of the participants, 542 were Jewish Israelis (69.8%) and 235 (30.2%) were Arab Israelis. The average age was 32.98 years (SD = 12.98) and the average number of years of education was 12.26 (SD = 5.21). Two hundred and forty-seven participants (31.8%) reported a high financial status, 157 (20.2%) reported an average financial status, and 367 (47.2%) reported a low financial statue. Among the participants, 115 (14.8%) had been closely acquainted with a person who died of COVID-19, 227 (35.6%) had been remotely acquainted with a person who died of COVID-19, and 381 (49%) did not know anyone who had died of COVID-19. Fifty-three participants (6.8%) had been infected in the past with COVID-19 and had had that diagnosis confirmed by a doctor, 33 (4.2%) believed that they had been infected, but had not had that diagnosis medically confirmed, and 691 (88.9%) had not been infected. One hundred and forty-four of the participants (18.5%) reported that they had COVID-19 risk factors and 632 (81.3%) reported that they did not have any such risk factors.

Measures

Demographic questionnaire

This questionnaire covered variables such as age, gender, education, acquaintance with someone who died of COVID-19, and having been infected with COVID-19.

PTSD symptoms

PTSD symptoms were evaluated using the short form of the PTSD checklist for DSM-5 (PCL-5) developed by Zuromski, and colleagues (Zuromski et al., 2019). This scale is a short version of the PCL-5 that includes one item assessing each of the DSM-5 Criteria B – E. The scale includes a four-item form that reflects PTSD symptoms. The severity of each item is rated on a 4-point Likert scale ranging from 1 (not at all) to 4 (severely). The Cronbach’s alpha internal consistency coefficient for the scale was .78.

Anxiety

Anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006). This is a seven-item instrument corresponding to the diagnostic criteria for generalized anxiety disorder. The severity of each item is rated on a 3-point Likert scale ranging from 1 (not at all) to 3 (almost every day). The Cronbach’s alpha internal consistency coefficient for the scale was .91.

Mastery

Mastery was examined using the mastery scale developed by Pearlin and Schooler (1978). This scale contains seven items ranging from 1 (not appropriate) to 7 (very appropriate). The Cronbach’s alpha internal consistency coefficient for the scale was .78.

Tendency to forgive

Tendency to forgive was examined using the Heartland Forgiveness Scale (HFS; Thompson et al., 2005). This questionnaire includes 18 items that are rated on a 7-point Likert scale ranging from 1 (almost always false of me) to 7 (almost always true of me). This scale includes three subscales that examine forgiveness of self, others, and situations. The Cronbach’s alpha internal consistency coefficient for the HFS scale was .85.

Optimism

The Life Orientation Test-Revised (LOT-R; Scheier et al., 1994) was used to assess optimism. The LOT-R consists of 10 items: six relevant items (e.g. ‘In uncertain times, I usually expect the best’) and four irrelevant items (e.g. ‘It’s easy for me to relax’). The irrelevant items weren’t calculated when the scale was comprised. Participants provided a response for each item using scales ranging from 1 (I strongly disagree) to 5 (I strongly agree). The internal consistency coefficient for the LOT-R was .74.

Resilience

Resilience was examined using the 10-item CD-RISC (Campbell‐sills & Stein, 2007). This scale is a shortened version of the original CD-RISK scale (Connor & Davidson, 2003). It includes 10 items that are rated on a scale ranging from 0 (never) to 4 (almost always). The Cronbach’s alpha internal consistency coefficient for the scale was .83.

Procedure

Following the approval of the University’s ethics committee, an initial request to take part in the study was distributed through various social-media groups (Facebook, WhatsApp, etc.), along with explanations of the importance and goal of the study. Data collection was completely conducted online and all of the sections of the questionnaire were completed. The study took place during the third wave of the pandemic, and questionnaires were distributed for approximately two months. Those who agreed to take part in the study accessed a link to the study’s informed-consent form and the study questionnaires. All participants voluntarily completed the questionnaires.

Data analyses

In the first stage of the data analysis, we examined the means of the research variables and their standard deviations, as well as correlations between those variables (Table 1). As shown in Table 1, negative correlations were found between mastery and PTSD (r = −.36; p < .01), forgiveness and PTSD (r = −.35; p < .01), optimism and PTSD (r = −.24; p < .01), and resilience and PTSD (r = −.27; p < .01). Negative correlations were also found between mastery and anxiety (r = −.40; p < .01), forgiveness and anxiety (r = −.39; p < .01), optimism and anxiety (r = −.35; p < .01), and resilience and anxiety (r = −.30; p < .01).

Table 1. Means, standard deviations, and correlation between PTSD, anxiety, mastery, forgiveness, optimism, and resilience.

	M	SD	PTSD	Anxiety	Mastery	Forgiveness	Optimism	Resilience
PTSD	2.21	.92		.63**	−.36**	−.35**	−.24**	−.27**
Anxiety	1.78	.69			−.40**	−.39**	−.35**	−.30**
Mastery	5.07	.90				.44**	.41**	.49**
Forgiveness	4.80	.78					.44**	.48**
Optimism	2.66	.70						.52**
Resilience	3.31	.48

**p < .001.

In the second stage of the data analysis, a stepped hierarchical multiple regression was conducted to ascertain the relative contributions of the study variables to PTSD symptoms and to anxiety (Table 2). The study variables included demographic and general variables (Step 1: cultural group, age, education, financial situation, acquaintance with a person who died of COVID-19, membership in a high-risk group for COVID-19, and having been infected with COVID-19 in the past) and personal-resource variables (Step 2: mastery, forgiveness, optimism, and resilience). As shown in Table 2, with regard to PTSD symptoms, in Step 1, the explained variance was R² = .11 (p < .01) and that variance could be explained by cultural group (i.e. Arab participants were more likely to report traumatic symptoms than Jewish participants), age (i.e. younger participants more likely to report for traumatic symptoms), acquaintance with a person who died of COVID-19, membership in a high-risk group, and having been infected with COVID-19 in the past. In the second step, when mastery, forgiveness, optimism, and resilience were entered, mastery and forgiveness accounted for an additional portion [R² change =.13 (p < .01)] of the explained variance. In total, the explained variance in Step 2 was R² = .24 (p < .01) and cultural group, age, acquaintance with a person who died of COVID-19, having been infected with COVID-19 in the past, mastery, and forgiveness all contributed significantly to the explained variance.

Table 2. Hierarchical multiple regression of cultural group, age, education, financial situation, acquaintance, membership in a high-risk group, having been infected with COVID-19 in the past, mastery, forgiveness, optimism, and resilience with PTSD symptoms and anxiety.

	PTSD symptoms					Anxiety
	Step 1		Step 2		R^2	Step 1		Step 2		R^2
	Sig	β	Sig	β		Sig	β	Sig	β
Ethnicity ^a	<.001	.18	<.001	.13	Step 1	.03	.08	.51	.02	Step 1
Age	<.001	−.14	<.001	−.16	.11**	.03	−.09	.02	−.09	.05**
Education	.14	−.06	.91	.00	Step 2	.17	−.06	.84	.00	Step 2
Financial situation	.09	.06	.68	.01	.24**	.00	.11	.18	.05	.25**
Acquaintance	.002	−.11	<.001	−.13		.052	−.07	.01	−.09
Risk group	<.001	−.14	.004	−.11		.00	−.13	.03	−.08
Infected	.024	−.08	.03	−.07		.20	−.05	.25	−.04
Mastery			<.001	−.21				<.001	−.23
Forgiveness			<.001	−.23				<.001	−.23
Optimism			.71	−.02				<.001	−.17
Resilience			.79	−.01				.347	.04

^aJewish = 1; Arab = 2.

*p < .05. **p < .01.

With regard to anxiety, in Step 1, the explained variance was R² = .05 (p < .01) and that variance could be explained by cultural group, age, financial situation, membership in a high-risk group, and acquaintance with a person who died of COVID-19. (However, in Step 1, acquaintance with someone who had died of COVID-19 was marginally significant: p = .52). In Step 2, when mastery, forgiveness, optimism, and resilience were entered, mastery, forgiveness, and optimism accounted for an additional portion [R² change =.20 (p < .01)] of the explained variance. In total, the explained variance in Step 2 was R² = .25 (p < .01) and age, acquaintance with a person who died of COVID-19, mastery, forgiveness, and optimism all contributed significantly to the explained variance.

Discussion

This study aimed to examine the relationships between mastery, forgiveness, optimism, and resilience, and PTSD symptoms and anxiety during the COVID-19 pandemic. The study also examined general and COVID-19 variables, as well as the effect of cultural group (i.e. Jewish or Arab). In accordance with the study hypothesis, mastery and forgiveness were both associated with lower levels of PTSD symptoms and anxiety. These findings further demonstrate the importance of mastery and forgiveness as internal coping resources when dealing with traumatic and stressful situations (Ben‐tzur et al., 2021; Ha et al., 2019; Noh et al., 2012; Ochu et al., 2018; Weinberg et al., 2017). Moreover, in the context of COVID-19, while mastery and forgiveness have been associated with loneliness, depressive symptoms, and negative emotions (Fitzpatrick et al., 2020; Pizarro-Ruiz et al., 202 l; Refaeli & Achdut, 2021; Tilkeridou et al., 2021), our findings broaden the understanding of the relationship between mastery and forgiveness and emotional state in the face of COVID-19 by demonstrating their specific associations with lower levels of both PTSD symptoms and anxiety.

However, optimism was associated only with lower levels of anxiety and not with PTSD symptoms and resilience was not associated with PTSD symptoms or anxiety. It is possible that the stress and traumatic symptoms related to the COVID-19 pandemic differ from other types of stressful and traumatic events. As COVID-19 has affected the entire population, causing general stress, major disturbances to our daily routines, deep uncertainty about the future, and ongoing fear of being infected or of a significant other becoming infected, it is possible that direct positive resources may interact differently with the emotional stress. Therefore, although optimism and resilience have been found to be important resources when dealing with stress and trauma (Cherry et al., 2017; Gil & Weinberg, 2015; Lee et al., 2018; Stratta et al., 2015), in the context of COVID-19 and overwhelming and unpredictable stress it has imposed, individuals might find it hard to relate to direct positive resources. Therefore, while optimism could be related to anxiety, as demonstrated, individuals may find it harder to relate optimism to direct traumatic symptoms experienced in the context of COVID-19. Moreover, they might find it even harder to associate resilience with the unique circumstances of COVID-19, as resilience reflects the ability to adapt successfully to disturbances that threaten regular functioning (Masten, 2018).

When examining the relationships between cultural group and PTSD symptoms and anxiety, we found that the Arab participants were more likely to report PTSD symptoms than the Jewish participants. The Arab population in Israel is generally characterized by lower income per household, a lower prevalence of academic degrees, and larger numbers of family members living together under dense conditions, as compared to the Jewish population (Chasson et al., 2021). All of these are common risk factors for the development of PTSD. In addition, social and communal ties are extremely important in Arab communities and so the social-distancing requirements due to COVID-19 have greatly affected the foundations of the existing social fabric. Therefore, it is possible that when accounting for these risk factors and considering the fear of this virus and its harsh outcomes, the Arab population may be at greater risk for the development of PTSD symptoms.

In accordance with previous studies (Birditt et al., 2021; Klaiber et al., 2021), old age was associated with lower levels of PTSD symptoms and stress related to COVID-19. It is possible that the attention given to the older population and the need to keep those individuals safe from COVID-19 has positively affected their general sense of confidence and emotional state. It is also possible that the lockdowns and school closures may have had a greater impact on younger adults who have had to deal with a greater number of stressors such as watching their children at home every day, not going to work, and worrying about their parents and other older family members, all of which can lead to higher levels of anxiety and traumatic symptoms.

As could be expected, acquaintance with a person who died of COVID-19 and having risk factors for COVID-19 were associated with higher levels of PTSD symptoms and anxiety. However, having been infected was only associated with PTSD symptoms and not with anxiety. It is possible that those infected have suffered from different symptoms, which still trouble them and cause direct emotional distress. However, this distress might be more related to traumatic symptoms following their sickness and recovery rather than general anxiety. This discrepancy suggests the need for further examination of the different emotional responses to COVID-19 and the ways in which personal resources might interact with different forms of emotional distress.

Several limitations of this work should be addressed. First, the cross-sectional nature of this research prevents us from identifying any causal relationships. However, it should be considered that this study examined resources that are generally related to as personal traits. In this context, it is common to perceive personal traits as a stable resource also over time. In addition, PTSD symptoms were examined using a short scale. Although this study and previous studies have found that scale to reliably reflect PTSD symptoms, using the full scale could have possibly offered more data and allowed us to relate to PTSD clusters as well. In addition, although the study included a relatively large number of participants, since it did not involve a randomized sample, caution should be taken in generalizing these findings.

Despite these limitations, the findings of this study have important implications. When coping with emotional distress associated with COVID-19, it is important to be aware of the different emotional outcomes, especially PTSD symptoms and anxiety. In this context, we suggest that therapy programs should pay special attention to mastery and forgiveness as they are related to lower levels of both PTSD symptoms and anxiety. Awareness of the positive relationship between optimism and PTSD symptoms is also needed. Moreover, in governmental policies, special attention should be paid to minority groups as members of those groups might tend to experience more emotional distress and trauma symptoms. It is also suggested that medical and mental-health personnel be aware of those who have been in close acquaintance with people who died of COVID-19, those who have risk factors, and those who have been infected, as they may be at higher risk of experiencing PTSD symptoms and anxiety. We also suggest that efforts be made to further explore the relationship between resilience and emotional distress in the context of COVID-19. In conclusion, this study demonstrates the importance of being aware emotional distress while addressing personal variables.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

No funding was received for conducting this study. The authors have no relevant financial or non-financial interests to disclose. The study has been approved by the University’s Ethics Committee.